Recently, the U.S. Preventive Services Task Force (PSTF) published new recommendations for screening mammography in women. Their recommendations are to eliminate screening mammography in women age 40-49 years old unless they fall into a high risk category. The frequency of screening in women age 50-74 was decreased from annually to every two years. Previous recommendations were that routine screening for women at average risk for cancer occurs annually beginning at age 40. In addition the Task Force recommended against self breast exam. They based their conclusions and recommendations on a complex analysis of risk-benefit data. The study immediately caused much reaction in the press as well as the medical community.
These proposed changes are disturbing since I believe it will result in many new cases of breast cancer going undetected in younger patients. These changes partially stem from the “anxiety” caused by false-positive mammograms, which can trigger unnecessary further tests like biopsies. Other concerns are that a mammogram might find a genuine tumor that is growing so slowly that it might never actually be the cause of death.
There are several problems with this logic. There is no scientific way today of knowing for certain if a specific cancer within a woman’s breast, slow growing or not, won’t eventually progress and kill her. The decision to exclude women under age 50 from getting breast-cancer screening also ignores the fact that breast cancers in younger women tend to grow faster and more aggressively than do those in older women. This makes early detection even more important.
National statistics show that about 18 – 25% of the women diagnosed with breast cancer in the U.S. are ages 40-49. The PSTF’s proposals completely ignore all the women who are diagnosed when under age 40. Screening mammography is just as important as choosing a mammography facility which has dedicated breast imaging radiologists.
It is extremely likely that health insurers will use these recommendations as a means of denying payment for these services. Patients will then be forced to pay out of pocket if they would like the peace of mind. Just think of how many women will go along with these recommendations and eventually be diagnosed with a cancer which may be advanced when it would have been curable if diagnosed at a much earlier stage.
I fear what is next. Will they eventually deny PAP smears, colonoscopies and prostrate cancer screening? Let’s hope not.